Vitreous Management in Massive Suprachoroidal Hemorrhage

Quiroz-Mercado, H.; Garza-Karren, Carlos; Roig-Melo, Enrique A; Jimenez-Sierra, JM; Dalma-Weiszhausz, José

doi:10.1177/112067219700700117

Cited by 14 publications

(7 citation statements)

References 10 publications

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“…8,9 Optimal timing of intervention is also uncertain with most authors suggesting the use of ultrasound to detect blood liquefaction. 10 We took advantage of the 23G vitrectomy cannulas to ensure sclerotomies of known and reliable diameter and consistent patency throughout all surgical maneuvers.…”

Section: Discussionmentioning

confidence: 99%

Choroidal Hemorrhage Drainage Through 23-Gauge Vitrectomy Cannulas

Rossi¹,

Boccassini²,

Iossa³

et al. 2010

Retina

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Section: Discussionmentioning

confidence: 99%

Choroidal Hemorrhage Drainage Through 23-Gauge Vitrectomy Cannulas

Rossi¹,

Boccassini²,

Iossa³

et al. 2010

Retina

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“…8–10 Devices that may achieve intraoperative hemostasis and avoid these complications are divided into several categories: laser modalities, electrosurgery (surgical diathermy), electrocautery (thermal cautery), and regulating the intraocular tamponade. 11,12 Also, endodiode laser thermal treatments along with endotamponade (during a chorioretinal biopsy) 13 and aggressive diathermy combined with systemic hypotension have been described previously. 14 All such methods (except tamponade), involve the application of thermal energy to limit intraocular bleeding, which may, in turn, lead to collateral tissue injury.…”

Section: Discussionmentioning

confidence: 99%

A Model to Study Thermal Energy Delivery to the Choroid: A Comparison of Surgical Devices

LoBue

Tailor

Gandhi

et al. 2018

Trans. Vis. Sci. Tech.

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PurposeWe measure and compare surgical devices using an ex vivo, temperature-controlled, choroidal incision model during thermal energy transfer with a high-resolution infrared camera.MethodsEx vivo porcine choroidal tissue specimens (n = 516) were isolated and placed on a temperature-regulated (37°C) perfusion platform. We tested the pulsed electron avalanche knife (PEAK), micropulse laser (MpL), continuous laser (CL), and bipolar cautery (BpC) at three energy settings (11 [low], 45 [medium], and 134 [high] mJ/mm). Each device was clamped to a stationary mechanical arm. Movement of tissue specimens beneath the surgical device was achieved using a stepping motor-driven x-y table. An infrared video camera measured orthogonal temperature variation in the surrounding tissue.ResultsIncreased power resulted in greater lateral thermal spread using all modalities (P < 0.001). Mean (standard deviation) lateral thermal spread at low energy was smallest for the MpL at 0.0 (0.01) mm (P < 0.001), whereas BpC had the least collateral tissue damage at medium and high energies (0.02 [0.08] and 0.34 [0.22] mm, respectively; P < 0.001). Fluidics of the ex vivo system may limit thermal spread. The PEAK had the greatest thermal spread across all energy groups (P < 0.001), with clinically relevant variation between disposable blades.ConclusionsOur ex vivo model enabled direct comparison of threshold thermal tissue injury across four devices. MpL and BpC showed the least thermal damage. PEAK had a higher variation in energy delivery, but also has the advantage of more effective tissue cutting.Translational RelevanceOur ex vivo surgical device analysis provides thermal tissue injury predictions for choroidal surgery.

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“…This is an important prerequisite for passive drainage of the suprachoroidal space. In addition, most authors recommend combining suprachoroidal drainage with vitrectomy, since extensive choroidal haemorrhage is associated with a high risk of developing PVR amotio [5,6,44,45,47]. Not only can reattachment of the amotio usually present be carried out and a not uncommon concurrent vitreous haemorrhage be removed, but the suprachoroidal space can be more completely drained, for example, through the use of heavy fluid [48].…”

Section: Surgical Treatment Of Suprachoroidal Haemorrhagementioning

confidence: 99%

“…Dies ist eine wichtige Voraussetzung für die passive Drainage des Suprachorioidalraumes. Zudem empfehlen die meisten Autoren, die suprachorioidale Drainage mit der Durchführung einer Vitrektomie zu kombinieren, da ausgedehnte Aderhautblutungen mit einem hohen Risiko für die Entwicklung einer PVR-Amotio assoziiert sind [5,6,44,45,47]. Dabei kann nicht nur die Wiederanlage einer meist bestehenden Begleitamotio vorgenommen und eine nicht selten zusätzlich bestehende Glaskörperblutung entfernt, sondern z.…”

Section: Chirurgische Therapie Bei Suprachorioidalblutungunclassified

Surgical Management of Choroidal Diseases

Hattenbach

Bopp

Strobel

et al. 2021

Klin Monbl Augenheilkd

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Accumulation of serous fluid in the suprachoroidal space, known as uveal effusion, and choroidal or suprachoroidal haemorrhage (SCH) following rupture of ciliary blood vessels are considered rare, but serious, events with extremely poor functional prognosis. As a result, uveal effusion, and expulsive suprachoroidal haemorrhage in particular, continue to be considered as more or less fatal complications. However, clinical experience demonstrates that both clinical entities can be managed by conservative as well as surgical strategies, depending on their severity and localisation, with sometimes surprisingly favourable visual outcome. In addition to prognostic factors, timely recognition and prompt, if possible preventive, acute care, as well as carefully considered timing of adequate surgical measures taking advantage of the specific characteristics of the choroidal tissue, are crucial to treatment success. Along with technical advances in the field of vitreoretinal surgery, numerous variants of therapeutic approaches to the treatment of choroidal effusion and suprachoroidal haemorrhage have been proposed to date. This review presents some of the most important surgical techniques and strategies in the field.

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Vitreous Management in Massive Suprachoroidal Hemorrhage

Abstract: Total vitrectomy may be indicated in selected cases with MSCH. The successful outcome of these patients comes from the combination of vitrectomy and external drainage.

Cited by 14 publications

References 10 publications

Choroidal Hemorrhage Drainage Through 23-Gauge Vitrectomy Cannulas

Choroidal Hemorrhage Drainage Through 23-Gauge Vitrectomy Cannulas

A Model to Study Thermal Energy Delivery to the Choroid: A Comparison of Surgical Devices

Surgical Management of Choroidal Diseases

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